Evidence map›Paper›PMID 32457227›Full record

ArticleNeurology(R) neuroimmunology & neuroinflammation2020

COVID-19-related acute necrotizing encephalopathy with brain stem involvement in a patient with aplastic anemia.

Luke Dixon, James Varley, Anastassia Gontsarova, Dermot Mallon, Francesca Tona, David Muir, Asad Luqmani, Ieuan Harri Jenkins, Richard Nicholas, Brynmor Jones and 1 more

Open access · goldAbstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology(R) neuroimmunology & neuroinflammation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 131 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
131citing papers in PubMed, 13 pooled it
4.8field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

131 citing papers in PubMed, 13 syntheses or guidelines pooled it, 207 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. COVID-19 associated brain/spinal cord lesions and leptomeningeal enhancement: A meta-analysis of the relationship to CSF SARS-CoV-2.Journal of neuroimaging : official journal of the American Society of Neuroimaging · 2021
    Pooled it
  5. Pooled it
  6. Pooled it
  7. COVID-19, de novo seizures, and epilepsy: a systematic review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2021
    Pooled it
  8. Pooled it
  9. Pooled it
  10. Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2020
    Pooled it
  11. Pooled it
  12. Pooled it
  13. Pooled it
  14. Review
  15. Article
  16. Article
  17. Article
  18. Reemerging Infectious Diseases and Neuroimmunologic Complications.Neurology(R) neuroimmunology & neuroinflammation · 2025
    Review
  19. Article
  20. Review

71 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 1 institution in 3 countries.

Luke DixonFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom. Luke.dixon1@nhs.net.
James VarleyFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom.
Anastassia GontsarovaFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom.
Dermot MallonFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom.ORCID 0000-0001-7434-1201
Francesca TonaFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom.
David MuirFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom.
Asad LuqmaniFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom.
Ieuan Harri JenkinsFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom.
Richard NicholasFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom.ORCID 0000-0003-0414-1225
Brynmor JonesFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom.
Alex EverittFrom the Department of Imaging (L.D., A.G., D. Mallon, F.T., B.J.), Imperial College Healthcare NHS Trust; Department of Neurosciences (J.V., I.H.J., A.E.), Imperial College Healthcare NHS Trust; Northwest London Pathology (D. Muir); Department of Hematology (A.L.), Imperial College Healthcare NHS Trust; Centre for Neuroinflammation and Neurodegeneration (R.N.), Faculty of Medicine, Imperial College London; and Department of Visual Neuroscience (R.N.), UCL Institute of Ophthalmology, London, United Kingdom.
Imperial College Healthcare NHS Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo describe a novel case of coronavirus disease 2019 (COVID-19)-associated acute necrotizing encephalopathy (ANE) in a patient with aplastic anemia where there was early brain stem-predominant involvement.

methodsEvaluation of cause, clinical symptoms, and treatment response.

resultsA 59-year-old woman with a background of transfusion-dependent aplastic anemia presented with seizures and reduced level of consciousness 10 days after the onset of subjective fever, cough, and headache. Nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus (SARS-CoV-2) was positive, and CT during admission demonstrated diffuse swelling of the brain stem. She required intubation and mechanical ventilation for airway protection, given her reduced level of consciousness. The patient's condition deteriorated, and MRI on day 6 demonstrated worsening brain stem swelling with symmetrical hemorrhagic lesions in the brain stem, amygdalae, putamina, and thalamic nuclei. Appearances were consistent with hemorrhagic ANE with early brain stem involvement. The patient showed no response to steroid therapy and died on the eighth day of admission.

conclusionsCOVID-19 may be associated with an acute severe encephalopathy and, in this case, was considered most likely to represent an immune-mediated phenomenon. As the pandemic continues, we anticipate that the spectrum of neurologic presentation will broaden. It will be important to delineate the full clinical range of emergent COVID-19-related neurologic disease.

Indexed as

AmygdalaAnemia, AplasticBrain EdemaBrain StemCoronavirus InfectionsCOVID-19DexamethasoneDiffusion Magnetic Resonance ImagingFatal OutcomeFemaleGlucocorticoidsHumansIntracranial HemorrhagesLeukoencephalitis, Acute HemorrhagicMagnetic Resonance ImagingMiddle AgedDexamethasoneGlucocorticoids

Identifiers

PMID32457227
PMCPMC7286661
OpenAlexW3032104273

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.